Uganda: A success story in the fight against AIDS
By Todd Fillmore

There is an old axiom that, if you give someone a hammer, everything begins to look like a nail. What then, if you give them a train-load of condoms? 

Sadly, precisely such tunnel-vision has dominated the West’s approach to HIV/AIDS, resulting in a bitter debate over the most effective methods to combat this growing pandemic, with a divisive focus on two: Abstinence, or condoms. Given the increasingly hyper-sexualized West, it is no surprise that the vast majority of AIDS experts favor willy-nilly distribution of condoms over programs emphasizing behavior change.

At the center of this debate is Uganda, which has achieved remarkable and unique success, wrestling its peak infection rate from 21% in 1989 to a low of 6% in 2002. This radical reduction remains unmatched in the world, least of all by its southern African neighbors, many of whom still suffer double digit infection rates as high as 33%, with only marginal improvements.

While most of Sub-Saharan Africa was looking to Western AIDS pundits and their purses, in 1986 Uganda began crafting its own approach to AIDS, with little outside influence. The result was their balanced "ABC" program – (A)bstinence, (B)e faithful, and, if you must, (C)ondoms, with the primary emphasis on the first two. A subset of this program was "Zero Grazing", aimed at reducing the number of casual liaisons, as much of Africa practices informal polygamy. These behavioral change strategies did not appear out of thin air. The President of Uganda, Yoweri Musevini, and his wife Janet are self-described Christians, and have emphasized the role of Biblical values in their governing; rejecting the condom-heavy approach that has swept the world. As Musevini states, "I look at condoms as an improvisation, not a solution," and that "optimal relationships based on love and trust instead of institutionalized mistrust (which is what the condom is all about)," are the real solutions. Unafraid of religious influence to effect a solution, Musevini employed faith-based programs to help deliver his message of behavioral change, one of which was referred to as the Anglican Church project.

The fruits of these efforts are telling. A USAID survey tracked the results of the Anglican Church project in 1995, showing that those reporting two or more sexual partners plummeted from 86% to 29% for men and from 75% to 7% for women. Contrastingly, regular use of condoms rose from 5% to only 6% in the same period. When surveyed, Ugandans have overwhelmingly stated that their primary behavior change to avoid AIDS was sticking to one partner, except ages 15-19, whose first answer is delaying or abstaining from sex. In stark contrast, African countries with the highest condom use and availability also have some of the highest HIV infection (Botswana, Zimbabwe, South Africa). 

Enter politics. After Uganda’s low of 6% in 2002, there began a small but noticeable rise in the median infection rate, now hovering at around 7.5%. Ignoring the elephant in the room, AIDS officials and liberal pundits loudly insisted the uptick was due to Uganda’s emphasis on A and B, and not enough on C, often grossly mischaracterizing "ABC" as "abstinence only." They berate balanced programs like those of the Bush administration, who insisted that the $15 billion destined for Africa should be split evenly among the three components. Into the fray has leapt Dr. Edward C. Green, Senior Research Scientist at Harvard Center for Population and Development Studies, veteran AIDS researcher, Presidential Advisor, and author of the groundbreaking book "Rethinking AIDS prevention." In 2002 Green warned that, due to "funding priorities of foreign donor organizations", Uganda had, by the late ‘90s begun to drift away from its successful ABC model toward one of "medical solutions" (i.e. condoms and drugs). He prophetically warned that infections would begin to rise – and so they have.

Dr. Green, a self-described liberal, has much to say about the AIDS establishment. He points to the disparity between the evidence that behavior change (not condoms) was primarily responsible for Uganda’s AIDS decline, and the establishment’s lopsided emphasis on condoms, which get the majority of resources. He cites a 2002 letter from Kenyan AIDS officials, who complain that if they wished to accept $10 million in U.S. aid, they had to spend it all on condoms, and recent UN policy which recommends only condom use as a primary statistical indicator. In an informal search of abstracts from the AIDS conference in Barcelona, Green notes that references to "condoms" show up about 31 times more commonly than "abstinence", and 49 times more than "faithfulness". Dr. Green opines that such refusal to look beyond the latex lense is a tenacious legacy of the sexual and homosexual "revolutions" of the 60’s.

The hyper-focus on condoms is irrational and dangerous - not only in light of Uganda’s nearly solitary success, but also by virtue of dozens of accepted facts about condom limitations. Condoms are only 85% effective against pregnancy, and demonstrate a troubling inability to stop HIV transmission. Dr. Green notes that a startling meta-analysis found HIV infection occurred in approximately 20 percent of couples despite consistent condom use in vaginal sex. Indeed, reputable estimates of condom effectiveness range widely, from 35.4% to 94.2%. Condoms also do not stop common STI’s like HPV and Herpes simplex. According to University of Toronto professor Rupert Kaul, Africans with Herpes Type 2 (which infects up to 70% of local populations) are 10 times more likely to contract HIV. This possible Herpes/condom/HIV connection is unlikely to get attention from the AIDS establishment. 

We are witnessing a collision of worldviews. One view, fortified by empirical evidence, shows that diseases like AIDS are spread by casual sexual behavior, and that the only "safe" sex is within the confines of a faithful marriage: a worldview fully resonant with Biblical and Natural Law observations. The opposing view, held by the majority of AIDS experts, holds that there should be no consequences to reckless sexual behavior, regardless of evidence to the contrary. Consider this unguarded statement by a respected American AIDS "expert": 

"Unlike gibbons and some other mammals, humans are not naturally monogamous. Some major religions make poly-partnering (having sex with several partners) a sin in order to promote monogamy. However, there is nothing intrinsically wrong with poly-partnering. Indeed, poly-partnering allows participants to enjoy a greater variety of sexual behaviors, with a greater number of persons, to enhance their lovemaking skills. What if religions were to dictate that it was morally wrong for people to eat out at different restaurants, requiring its adherents to stick to one restaurant for their entire lives; or to stick to one movie--seeing the same film over and over again." (http://puffin.creighton.edu/aarg/prevention.html)

-- Todd Fillmore, Vermont Renewal (www.vermontrenewal.org)